FSO News

14 Health

Neuchâtel, october 2016

Cause of death statistics 2014 Assisted and suicide in

In 2014, 742 cases of were registered in Assisted suicide by gender 1998–2014 G 1 ­Switzerland. The Federal Statistical Office is issuing a report 500 on this for the second time. When is assisted suicide resorted to, who is affected and what are the underlying diseases? 400 How do cases of assisted suicide differ from the just over 1000 300 suicide cases? 200

100 Assisted suicide involves giving a person who wishes to end his 0 or her life a lethal substance which they take themselves without 1998 2000 2002 2004 2006 2008 2010 2012 2014 any outside influence. In Switzerland, the first “” organi- Women Men sations were formed around 35 years ago. Organisations such as EXIT and Dignitas assist persons wishing to commit suicide in Source: FSO – Cause of Death Statistics © FSO 2016 the framework of Article 115 of the Criminal Code. This does not forbid suicide assistance if there are no selfish motives. In 2014, the FSO registered 742 cases of assisted suicide Assisted suicide 2000–2014 G 2 among persons resident in Switzerland. This is equal to almost 1.2% of deaths and is 26% more than the previous year. Since Rate* per 100,000 inhabitants 12 2008, this figure has increased every year. 10 While slightly more men than women resorted to assisted 8 suicide in the early years, considerably more women have done 6 so since 2001 (G1). The male to female ratio is 10 to 13. 4 The figures for assisted suicide continue to rise. This re- 2 flects to some extent the increasing number of old persons in 0 ­Switzerland. The age-standardised assisted suicide rates1 show 2000 2002 2004 2006 2008 2010 2012 2014 slightly less growth compared with the absolute figures. It is Men Women striking that these rates are very close for both men and women * European standard population 2010 (G2). It should be noted that cases before 2009 have not been fully recorded. Source: FSO – Cause of Death Statistics, calculations Obsan © FSO 2016

1 The age-standardised mortality rates take into account the considerable growth and ageing of the population in this period.

Espace de l’Europe 10 CH-2010 Neuchâtel www.statistics.admin.ch FSO NEWS

Age Concomitant diseases reported with assisted suicide, period 2010–2014 G 5 Any person capable of judgement can resort to assisted suicide regardless of age. From 2010–2014, 94% of persons concerned were 55 years or over. In the 5-year period, thirteen persons were Parkinson‘s Disease under 35; this corresponds to 0.5% of cases (G3). Amyotrophic lateral sclerosis (ALS) The age distribution is similar for men and women. From the Multiple sclerosis age of 45 onwards, more women resort to assisted suicide in con- Dementia crete figures with the difference increasing with increasing age. Other neuro- degenerative diseases Assisted suicide by age, periods 2005–2009 and 2010–2014 G 3 Depression Unknown Cardiovascular diseases Blindness Neurodegene- Musculoskeletal rative diseases diseases 40 Diabetes Other Cancer Lung diseases 30 In 98.5% was a concomitant disease indicated.

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Percentage 10

0 Canton of residence 15–24 25–34 35–44 45–54 55–64 65–74 75–84 85–94 95 + Age groups Figure G6 shows the proportion of assisted per 2005–2009 2010–2014 1000 deaths by canton for the 2010 to 2014 observation pe- riod. The highest proportion of cases is found among persons Source: FSO – Cause of Death Statistics © FSO 2016 resident in the canton of Zurich with 14 per mille. In the canton of ­Geneva, this proportion is 13 per mille, in Neuchâtel 12, in ­Appenzell ­Ausserrhoden 11, in Vaud 10 and in Zug 9 per mille. Assisted suicide by age and gender, 2010–2014 G 4 All other cantons are below the Swiss average. In Uri and ­Appenzell Innerrhoden there were no cases in this five year pe- Number of cases riod. In absolute figures, the cantons of Zurich, Bern and Vaud 500 also registered the most cases. Since 1998, at least one person 400 in every canton has resorted to assisted suicide.

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200 Assisted suicide by canton of residence, 2010–2014 G 6

100 In per mille of all deaths 0 16.0 15–24 25–34 35–44 45–54 55–64 65–74 75–84 85–94 95+ 14.0 Women Men 12.0 10.0 Swiss mean Source: FSO – Cause of Death Statistics © FSO 2016 8.0 6.0 4.0 Concomitant diseases 2.0 0.0 TI AI BL LU BE SZ GL VS JU BS FR ZG GE TG NE SO VD SG AR AG ZH SH UR GR OW Assisted suicide is carried out if life no longer appears worth NW living to the person concerned, particularly due to a serious Source: FSO – Cause of Death Statistics © FSO 2016 physical illness (G5). In 42% of cases, cancer was reported as the underlying disease, 14% suffered from a neurodegenerative disease, 11% from a cardiovascular disease and 10% from a A comparison of assisted suicide and suicide musculoskeletal disorder. The group of other diseases includes chromic pain syndromes, multimorbidity and further diseases. From 1995 to 2003, the absolute number of suicides fell consider- Depression was reported in 3% of cases and dementia in 0.8% ably. Since then, it has more or less remained stable while cases of cases (G5). of assisted suicide have increased considerably since 2008 in particular. In 2014, for 7 cases of suicide observed, 5 cases of assisted suicide were seen (G7).

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Assisted suicide and suicide 1995–2014 G 7 The ratio of assisted suicide to suicide varies greatly depending on age. Assisted suicide is more common than suicide among Number of cases those aged 75 and older (2010–2014 period; G8). 1 600

1 200

800 Suicide

400 In 2014, 1029 persons (754 men, 275 women) died of suicide in 0 1995 1997 1999 2001 2003 2005 2007 2009 2011 2014 Switzerland. In 1995, 1400 persons a year died from suicide (G9)

Assisted suicide Suicide while in the mid-1980s this figure was 1600 persons per year. Figure G10 shows the trend of age-standardised mortality Source: FSO – Cause of Death Statistics © FSO 2016 rates for suicide. The probability of suicide has almost halved since 1990. Among men, it fell from 39 to 20 per 100,000 be- tween 1991 and 2010, among women from 12 to 7 per 100,000. Assisted suicide and suicide by age, The figures have remained relatively stable since 2010. period 2010–2014 G 8 If one considers the total number of assisted suicides and sui-

Mean number of cases per year cides, it can be seen that the increase here compensates for the 250 decrease over the last 10 years. It should be remembered, how- 200 ever, that this only partly concerns the same group of persons. 150 Assisted suicide is a relatively new phenomenon which mainly 100 affects persons with serious diseases leading to death. 50 0 15–24 25–34 35–44 45–54 55–64 65–74 75–84 85–94 95+ Suicide by gender 1995–2014 G 9 Assisted suicide Suicide 1 200

Source: FSO – Cause of Death Statistics © FSO 2016 1 000

800

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Background 400 In 2011–2012, the Federal Council and Parliament decided 200 to dispense with an explicit legal provision on organised as- 0 sisted suicide. They concluded that it is possible to prevent 1995 1997 1999 2001 2003 2005 2007 2009 2011 2014 and detect abuse using the existing legal regulations. The Women Men Federal Council and Parliament contribute to consolidat- ing the right to self-determination with various measures: Source: FSO – Cause of Death Statistics © FSO 2016 e.g. through improved coordination of prevention and early detection of mental disorders, the action Suicide, development 1990–2014 G 10 plan, the palliative care platform and improved coordination

provision e.g. for multimorbid persons. Rate per 100,000 inhabitants, european standard population 2010 40 Additional information 30 Federal Office of Public Health – Mental health and suicide prevention dossiers (available 20 in German, French and Italian): ­www.­bag.­admin.ch R Themen R Gesundheitspolitik R Psychische­ Gesundheit 10

– Palliative care dossier: www.bag.admin.ch R Topics R 0 Health policy R Palliative Care Strategy 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 – Coordinated provision dossier (available in German, Men Women French and Italian): www.bag.admin.ch R ­Themen R Men incl. assisted suicide Women incl. assisted suicide Gesundheitspolitik R koordinierte Versorgung Source: FSO – Cause of Death Statistics, calculations Obsan © FSO 2016 Federal Office of Justice – www.bj.admin.ch R Society R Bills adopted R Euthanasia

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Diseases present in the case of suicide Data source and procedure In 53% of cases, causes of death registrations for suicide do not Since the end of the 1990s, the FSO has received isolated contain any information about concomitant diseases. If no infor- notifications of assisted suicide. As the International mation is available, this may mean various things: either no dis- ­Classification of Diseases (ICD-10) does not have any code ease was present or it was unknown. If information is available, for this, in the beginning these cases were classified as sui- 56% of entries cite depression. In the remaining 44% of entries, a cide by . However, the WHO rules stipulate that physical disease is mentioned. Physical diseases include a range the disease to be entered as the cause of death should be similar to that of assisted suicide (G11). the originating cause of the sequence that led to death. In this sense, assisted suicide is usually the last resort taken Concomitant diseases reported with suicide, at the end of a serious disease. period 2010–2014 G 11 Since 2009, assisted suicide has been coded consistently as concomitant with death. Cases from years 1990 to 2008 were recorded retrospectively insofar as possible. Other

Parkinson‘s Disease cases where there was only a suspicion of assisted suicide are attributed to suicide. For the years from 2004, unclear Multiple sclerosis Dementia cases are rare. Amyotrophic lateral The Swiss Cause of Death Statistics were introduced in sclerosis (ALS) 1876. They are based on the medical certificate of cause of

Other neuro- death. ­Diagnoses are recorded in words, the coding is based degenerative diseases on the ICD-10 and is conducted in the Federal Statistical ­Office according to the rules defined by the WHO. All col- Depression Neurodegenerative Musculoskeletal lected data are treated anonymously and strictly confiden- diseases diseases Blindness tially and are subject to the provisions of the Federal Data Diabetes Cancer Lung diseases Protection Act of 19 June 1992 (SR 235.1). Publications on Other Cardiovascular diseases the Cause of Death Statistics refer to persons who are resi- In only 46% was a concomitant disease indicated. dent in Switzerland, i.e. on the permanent resident popula- tion regardless of nationality and place of death. Source: FSO – Cause of Death Statistics © FSO 2016

Suicide methods Further information on the cause of death statistics on the internet: The most common suicide method is , one third of men www.statistik.ch R Topics R 14 – Health R Health of the popu- and one quarter of women who commit suicide use this method. lation R Mortality, causes of death This is followed in second place by shooting oneself (27% of men but only 3% of women). 14% themselves (and one quarter of women), 12% jump form a height or throw themselves in front of a moving vehicle and 11% use another method (G12).

Suicide Methods by gender, period 2010–2014 G 12 Published by: Federal Statistical Office (FSO) Information: Health information service, tel. 058 463 67 00 Men [email protected] Author: Chrstoph Junker, GESB, tel. 058 463 68 30 Women Series: Swiss Statistics Topic: 14 Health Original text: German Translation: FSO language services Layout: DIAM Section, Prepress/Print Graphics: DIAM Section, Prepress/Print N=281 Front page: FSO; Concept: Netthoevel & Gaberthüel, Biel; Photograph: © Auke Holwerda – istockphoto.com N=755 Copyright: FSO, Neuchâtel 2016 Hanging Jumping from height Cutting Reproduction with mention of source authorised Poisoning Vehicular impact Other (except for commercial purposes) Shooting Orders: Federal Statistical Office, CH-2010 Neuchâtel, tel. 058 463 60 60, fax 058 463 60 61, [email protected] Surfaces are proportional to the absolute number of cases. Price: Free of charge

Source: FSO – Cause of Death Statistics © FSO 2016 FSO number: 1260-1400

Corrected Version 24.11.2017: Page 4, Graphic G12

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